Charting developments on the Affordable Care Act

Employer Responsibilities

Health Plans Required To Obtain Unique Identification Number under HIPAA

It has taken the federal government a long time to implement the requirement that health plans obtain a unique identification number under HIPAA, but a deadline has been set. Larger plans (with receipts of at least $5 million) must obtain this ID number by November 5, 2014. Smaller plans have an additional year to obtain it. The ID number will primarily be used in HIPAA-covered electronic transactions to streamline the transmission of health information, but it may have alternative uses, for example, under new rules that require a health plan to obtain a certification of compliance with certain of HIPAA’s electronic transaction standards by the end of 2015.

The government has published guidance on the ID requirement and on the application process. Unfortunately, this guidance fails to answer certain basic questions about the requirement, such as whether a plan needs an ID number if the plan itself never engages in any HIPAA-covered electronic transactions and when a single ID number would be sufficient for different but related health plans or options. Such uncertainties have prompted some commentators to suggest that plan sponsors delay their efforts to obtain the ID number. However, absent further guidance, employers may delay only so long. The process for obtaining the ID number involves multiple steps and can be cumbersome. Employers should allow adequate lead time to complete the process.

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About The Health Care Reform Initiative

As the federal health care reform effort gained steam, attorneys in Ballard Spahr's Health Care and Employee Benefits and Executive Compensation Groups formed an initiative to monitor and analyze legislative developments. With federal health care reform now a reality, our attorneys are assisting health care entities and employers in understanding the relevant changes and planning for the future.